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Screening for Iron Deficiency - Abu Osba Medical

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    Screening for Iron Deficiency - Abu Osba Medical Screening for Iron Deficiency - Abu Osba Medical Presentation Transcript

    • Screening for Iron Deficiency Prepared by Maa’n I.Mesmeh,M.D. Moderated by Dr. Yousef Abu-Osba
    • Screening for Iron Deficiency
      • Definitions
      • Epidemiology
      • Pathogenesis
      • Clinical Aspects
      • Making the Diagnosis
      • Laboratory Parameters
      • Diet
      • Prevention
    • Screening for Iron Deficiency
      • Introduction :
      • why it is an important health problem ?
      • Its serious sequelae
      • Its prevalence
      • Still seen frequently
    • Screening for Iron Deficiency
      • Anemia :
      • Definition
      • Causes
      • Categorizing
      • Iron :
      • Depletion
      • Deficiency
      • Iron deficiency anemia
    • Screening for Iron Deficiency
      • Epidemiology :
      • WHO estimates : most of the world’s population are iron deficient , one third have anemia .
      • High prevalence in the late 1960s led to the introduction of preventive programs .
      • WIC act
      • Iron deficiency remains common in the developed countries & sever cases still occur .
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    • Screening for Iron Deficiency
      • Attributable factors are different in the developing countries from developed countries .
      • Some sectors of the population are more susceptible .
      • The difference between the infants & toddlers in regard to fortification of formula , diet & cow milk ingestion .
      • The difference between the male & the female .
      • In the first months of life no role for iron deficiency .
    • Screening for Iron Deficiency
      • Pathogenesis :
      • Site
      • Role
      • Absorption :
      • heme & nonheme
      • inhibitors of iron absorption
      • enhanced absorption
      • absorbability difference between human milk (50%) , cow milk (10%) , fortified formula (5%) .
    • Screening for Iron Deficiency
      • Transport
      • Source & Storage : developing fetus , depletion of 50% occurs in the first 4 months , depletion of the stores occur at 2-3 months in the preterm
      • Loss occur in GIT , urine & skin .
      • Daily needs ( o.8 mg/d : 0.6 growth , 0.2 for ongoing losses
    • Screening for Iron Deficiency
      • Clinical Aspects :
      • S&S depends on the degree of deficiency & on the rate of development of the deficiency
      • The most frequent sign is pallor
      • 10-15% splenomegally
      • Irritability & anorexia in infants & toddlers
      • 45% of sever cases were asymptomatic
      • Developmental delay : ? irreversibility
    • Screening for Iron Deficiency
      • Clinical Aspects :
      • Other S&S :
      • poor growth , blue sclerae , koilonychia , angular stomatitis , increased susceptibility to infections , GIT symptoms , increased lead absorption , pica & plumbism .
    • Screening for Iron Deficiency
      • Making the Diagnosis :
      • DDx narrows once classified as microcytic :
      • IDA
      • Thalassemia
      • Lead poisoning
      • Chronic disease
      • Sideroblastic anemia
    • Screening for Iron Deficiency
      • Making the Diagnosis :
      • The gold standard for identifying iron deficiency is bone marrow biopsy with Prussian blue staining .
      • Otherwise no single best test to diagnose iron deficiency
      • Hematological & biochemical tests are based on RBCs features & iron metabolism
      • Biochemical tests detect early iron deficiency
      • CHr is a new test
    • Screening for Iron Deficiency
      • Laboratory Parameters :
      • 1) Hematological Markers:
      • The changes through the spectrum from normal to IDA in :
      • * Hgb & MCV are late markers & less specific
      • * RDW is highly sensitive but has low specificity
      • * Reticulocytes : for assessing response to Rx .
      • * CHr : is the best predictor of iron deficiency among Hgb , MCV , s.iron , RDW & transferrin saturation .
    • Screening for Iron Deficiency
    • Screening for Iron Deficiency
      • Laboratory Parameters :
      • 2) Biochemical Markers :
      • *S.ferritin is the earliest marker of iron deficiency with high specificity
      • *S.iron is not accurate because it is affected by iron absorption , infection , inflammation & diurnal variation .
      • *TIBC measures iron-binding sites but affected by malnutrition , inflammation , chromic infection & cancer .
      • *Transferrin saturation (%) = s.iron ÷ TIBC
    • Screening for Iron Deficiency
      • Laboratory Parameters :
      • 2) Biochemical Markers :
      • *TfR by immunoassay . It presents in immature reticulocytes . It is early marker & can differentiate between IDA & chronic illness
      • *ZPP/heme is an early marker but not specific
    • Screening for Iron Deficiency
    • Screening for Iron Deficiency
      • Diet :
      • The dietary history is suggestive
      • IDA in one study defined as :
      • 1) < 5 servings per week
      • 2) > 16 oz milk per day
      • 3) Daily fatty snacks , sweets & > 16 oz soda.
      • In this case the history was 71% sensitive , 79% specific , 97% negative predictive value
    • Screening for Iron Deficiency
      • Prevention :
      • Primary
      • Secondary
      • AAP recommendation : Hgb & Hct once between 9-12 months & again after 6 months ( consider risk factor & prevalence in the population ) also all adolscence once between 11-21 years in addition to all mensruating females annually
    • Screening for Iron Deficiency
    • Screening for Iron Deficiency
      • Treatment :
      • oral iron salts
      • parenteral iron
      • PRBCs
      • Follow up : increase of 10 g /L after one month of Rx confirms the diagnosis
    • THANK YOU